Nursing Skills Checklist Form
Nurse's Name
First Name
Last Name
Evaluator's Name
First Name
Last Name
Evaluation Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please evaluate the following skills.
Rows
Highly Dissatisfied
Dissatisfied
Nutral
Satisfied
Highly Satisfied
Decision making
1
2
3
4
5
Mathematics
6
7
8
9
10
Analytical skills
11
12
13
14
15
Physical endurance
16
17
18
19
20
Observation
21
22
23
24
25
Patience
26
27
28
29
30
Compassion
31
32
33
34
35
Nonjudgemental
36
37
38
39
40
Teamwork
41
42
43
44
45
Communication skills
46
47
48
49
50
Dedication
51
52
53
54
55
Additional Comments
Evaluator's Signature
Submit
Should be Empty: